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The first study in Canada believed to look at serious weight problems — in toddlers — suggests one in four 18-month-olds is already overweight, obese or at risk of becoming overweight.

Experts say the “alarming” study shows the trend they were already seeing in older age groups is now extending down to the under two’s, resurrecting the question, who’s responsible when a toddler gets so heavy he has trouble moving?

One Toronto pediatrician says he is already seeing obese three- and five-month-old children.

Until now, there has been a dearth of data on rates of overweight children and obesity for those under three, the research team writes in this week’s issue of CMAJ Open.

“We knew that early childhood is the critical time for obesity prevention strategies,” said lead author Suzanne Biro, a former research associate in the department of family medicine at Queen’s University in Kingston, Ont. “If we intervene earlier, it’s easier to change the trajectory of weight gain.”

The study looked at weight and height (or length) measures for 8,261 children younger than 20 years taken from a sample of electronic medical records from family doctors and pediatricians in Ontario.

The study found that, overall in 2013, 28 per cent of children ages five to 19 were categorized as overweight or obese.

It’s really not an issue of parents not caring or being lazy. They’re just navigating a world where the odds are stacked against them

The researchers also extracted just more than 1,500 billing codes for 18-month “well baby visits” — a routine checkup — between 2008 and 2013. About seven per cent of this group was categorized as overweight or obese; 19 per cent were considered at risk of becoming overweight.

The researchers caution their study can’t be considered representative of Canadian children. However, their sample size was almost four times larger than the latest national survey to estimate overweight and obesity rates in children and teens — the 2009 to 2011 cycle of Statistic Canada’s Canadian health measures survey. As well, the StatsCan survey included only children aged three or older.

“Data speaks,” said Dr. Catherine Birken, who runs an obesity treatment program for children under six at Toronto’s Hospital for Sick Children, in collaboration with Toronto Public Health.

“I see these children in my clinical practice. So yes, it’s a problem,” Birken said.

The average height of a two-year-old is 86 centimetres (2-foot-8), explains Dr. Dan Flanders, a Toronto pediatrician at North York General Hospital who specializes in obesity and nutrition. A normal weight for a child this height is about 11.5 kilograms, or 25 pounds.

Serious health risks in obese toddlers are rare, he said. “But certainly we have five- and six-year-olds who have life-threatening conditions” such as severe sleep apnea or uncontrolled diabetes, he said.

With toddlers, “we certainly see more subtle stuff.” Heavy toddlers may have trouble reaching their “developmental milestones,” he said. “It’s harder to stand up, harder to walk, harder to run.”

“Probably by age two or three they might start to feel some of the shaming that people deliver to obese people — jokes that might be told about them by daycare providers, or their parents,” he added. “So, there’s some psychological risk there.”

Flanders is careful not to blame parents. “It’s really not an issue of parents not caring or being lazy. They’re just navigating a world where the odds are stacked against them,” including the ubiquitous availability of “cheap, crappy foods” that are heavily marketed to parents.

“Imagine how challenging it would be for a single mom who’s barely making it to serve fresh steamed vegetables and lean meat and a freshly cut salad,” said Flanders. “Our environment isn’t designed in a way to make that realistic, and helpful or easy. It makes more sense to stop at the drive-through and get your kids fed so they stop whining.”

Other times, food becomes a fallback to deal with temper tantrums, he said.

What’s most important, he said, “is figuring out what’s the most effective and humane way to approach this problem,” including more social services for families and regulating how high-fat, sugary foods are marketed to parents and children.

“Conveying a message to parents that it’s their personal responsibility and they need to ‘get it together and become better parents’ isn’t fair,” he said.

A controversial commentary published in a top medical journal in 2011 suggested parents should lose custody of children with life-threatening obesity. In cases where parenting training or counselling fail, “placement of the severely obese child under protective custody warrants discussion,” the authors argued.

“Despite a well-established constitutional right of parents to raise their children as they chose, the state may intervene to protect the child’s interest.”

There have been a handful of state interventions in the U.S. and elsewhere. In 2011, an eight-year-old Ohio boy weighing 200 pounds was placed in foster care after child welfare workers said the mother wasn’t doing enough to control his weight, according to The Plain Dealer in Cleveland, Ohio. Two years ago, the British paper The Guardian reported police had arrested the parents of an 11-year-old weighing 210 pounds on suspicion of neglect.

Renowned bioethicist Arthur Caplan says that, unlike starving a child, over-feeding a toddler doesn’t rise to the level of parental negligence unless “you’re into extreme morbid obesity” and there is an immediate threat to life.

“But we do have an obligation to step in and try help this child,” said Caplan, director of the division of medical ethics at New York University Langone Medical Centre.

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Trend in childhood obesity extends down as one in four Canadian toddlers too fat: study

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